How overweight do you have to be for insurance to cover bariatric surgery?

In our experience, the qualifying requirements are often:

  • BMI over 40 -OR-
  • BMI over 35 with one or more underlying health conditions (such as obstructive sleep apnea, coronary heart disease, medically refractory hypertension, or type 2 diabetes)

Coverage for your weight loss surgery is dependent on your specific insurance plan; and you will likely need to complete a few steps for coverage, i.e. complete a medically supervised diet program, schedule a psychiatric evaluation to obtain a mental health clearance letter, and schedule a nutritional evaluation from a Registered Dietitian. At the Nicholson Clinic, you will be assigned a Patient Care Advocate (PCA) to help you navigate this process.

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